Health

Why walking in their shoes will give you new insights.

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To understand someone better, it is said that we need to walk a mile in their shoes.

This is perhaps a little extreme but as with many statements, there is a lot of truth buried in there.

Walking in their shoes, or at least picking them up and looking closely at the wear patterns, both inside and out, will tell you much about the person’s interaction with the world. Do they currently have a prescription orthotic, or some form of insole? How has the outsole worn? Are both sides worn in the same way? Can you see the way the foot turns and loads inside the shoe?

By observing and considering the information provided, it can be possible to start gaining a better insight into how the person moves and hence any potential issues they may be adapting for.

If necessary, stand up and attempt to physically mimic their movement, and what leads them to that positioning.

Feeling it in your own body can be an eye opening experience and one that may hugely enhance your own practice.

5 tips for better sleep tonight.

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We all feel better after a good nights sleep but how often do you wake up wishing for more, and not refreshed and ready to go? The lack of sleep is sometimes considered a chronic health issue, due to its links with lots of other modern problems including diabetes, depression, and stress.

Up until open hundred years ago, our daily lives were regulated by the sun. Candles and lamps were expensive and comparatively ineffective, so we worked when the sun shone and rested when it set. Although our bodies expect this, it is no longer the case, thanks to the electric light and modern 24 hour entertainments giving us far too many reasons not to go to bed.

This means that we are saturated with blue light. From the backlights of our televisions and mobile devices to the harsh illumination of an LED or low energy bulb, blue is far more visually and cortically stimulating than older bulbs, triggering the brain into thinking it’s still daytime and interrupting melatonin production, a vital hormone that helps us sleep better.

So we often self medicate with alcohol. That drink that helps us calm down, feel relaxed and far too often doze off in front of the tv actually stimulates us a few hours later, as the sugars in it are metabolised and converted into fuel, which the body doesn’t actually need, leading to a restless night.

The result of which is the need for a stimulant in the morning to kick-start our day and another later to get us through the evening. But time these wrongly and yet another restless night will follow, repeating the pattern. It’s far better to suffer an afternoon of feeling sluggish but allow your adrenal glands to unwind and therefore help you sleep better than it is to take yet more energy drink.

But this stress is a chronic problem for many of us, where our bodies are constantly in a state of fight, flight or freeze, trapped in a biological cycle of not knowing how to respond to a situation it cannot control. We are flooded with cortisol, elevating blood pressure, blood glucose and adrenaline and when we finally collapse, exhausted into bed, we sleep tense, grinding our teeth, stiffening our muscles and waking once again feeling just as tired as when we pulled the covers up.

Similarly, we know exercise is good for us, but too much too late at night can have a stimulating effect, pumping up our blood supply and kicking the adrenaline levels back into action, just when we’d prefer to be unwinding. If you need to stay awake for long periods of time, simple whole body exercises have been shown to help, so why do it if you want to rest?

How to solve this modern health crisis? Research has shown that there are a few simple things we can do to make massive improvements in our sleep, which most of us did for our children yet forget to do for ourselves as we get older.

1) Turn off that screen. No blue lights, LEDs or TVs for at least an hour before bed. Instead read, bath, any activity you enjoy that allows you time to relax and unwind. Gradually turn the lights down, creating your own sunset effect and losing the blue.

2) Have a fixed routine. The body is controlled by circadian rhythms, patterns when it knows and expects events to happen. Experimentation and research has shown that melatonin is typically released between 9pm and 2am, so turning in at 10.30 would maximise your exposure to its beneficial effects. Also, getting up at the same time every day also helps stabilise the routine, improving productivity and effectiveness during the working day.

3) Sleep in the dark. Light is stimulating, be it a control LED on a clock radio or the dull glow of a tv on standby. Tape over them or even better, remove as many electrical items as you can from the bedroom. Think like a caveman, invest in blackout curtains or a really good eye mask.

4) Avoid eating or drinking anything stronger than water or herbal teas for a couple of hours before you sleep. You don’t need the energy in them, they are stimulating and you need to give your body time to digest and sort itself out. In terms of anything properly stimulating i.e. coffee or energy drinks, they have a long metabolic half-life, so at least 8 hours is a good window. In reality, this often means none after 2-3pm for many people.

5) If you are plagued with restless thoughts at night, get up, write them down and reset the pattern. If, in the morning, there is something that you know you can action, get it done and make steps to sorting it out. If there are more troubling issues surfacing regularly, go and see a professional for assistance. Whatever the problem, you are not the only person in the world with that issue.

Restful nights and busy days.

Wobbly sticks and string

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Most people have seen a tensegrity model. These are clever constructions of sticks and elastic that use balanced tension and compression to created self supporting shapes.

(Image taken from http://dotensegrity.blogspot.co.uk/2011/01/make-your-own-tensegrity-model.html)

It is possible to consider the body as a tensegrity model, where the bones, muscles and ligaments all act together to support, articulate and move.

Although simplistic and missing huge elements of the effects of fascia, organs, inflammation and so forth, it is a useful analogy to hold, especially when trying to educate patients.

Recently, I have been considering the lumbar spine and the need for good abdominal support around it. The metaphor I use it that of a wobbly stick attempting to link upper and lower halves of the body. The pelvis is a fairly stable, solid object and the thoracic spine is well held with the ribs. This leaves the cervical spine (a wobbly stick with a block on top) and Lumbar spine to do a lot of work. Therefore, we need plenty of active muscles recruited to provide stability, support and movement.

So, no matter how much we may train that six pack and work to get well toned abs, if we cannot recruit them during activity, its fairly pointless.

I have 3 basic exercises I start with for every patient and, if they can do those, move to the next level. These are:

Pelvic control: The patient lies supine, slides one heel up the couch or floor, whilst attempting to maintain a level pelvis, the ASIS not deviating significantly posteriorly. Recruitment of the TA is particularly useful in this.

Cat crunches: On all 4s, the patient pulls their navel towards the spine, attempting to keep everything else still. A count of 5 and release slowly. This helps recruit deep obliques and the thoracolumbar fascia attachments.

Gluteal raises (trendelenburg drops). The patient stands sideways on a step and allows one leg to drop. They raise it back up again, using the opposite glutes, minimising recruitment of QL or lumbar erector spinae if possible.

Once they’ve got these, then the neuromuscular paths are working better and we can progress to more dynamic tests.

No more wobbly stick, less back pain.

The use of compression wear in recovery from injury

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Many people use compression wear for racing, training and recovery. However, I’ve been thinking about using for recovery from injury.

As of yet, I haven’t been able to design a suitable controlled trial but we have been trialing it in clinic with some athletes and other active clients.

We noted that it seems to help improve recovery time in people with both calf injuries and tendonopathies. It appears that the compression wear (in this case compressport calf guards) helps reduce buildup of oedema when worn overnight and support the muscle during everyday activity during the day.

We are going to continue trialing this and hopefully will have sufficient day to draw a more solid conclusion soon but i thought i’d put it out there for general consideration. We are also going to try the quad guards for hamstring and quad injuries if suitable clients present.

Movement

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We need to move, we evolved through movement. Its just that with our current life choices, we don’t move enough. We have cars, internet shopping, sofas, take away food. We no longer need to hunt, track, think or work for dinner. Our survival no longer depends on moving.

If you watch a child, they move naturally and gracefully. No one has taught them to keep a straight spine and bend at the knees when lifting, they just do.

And if we look closer at their movement patterns in comparison to ours, we can see that they initiate their movements from the centre, the torso, long before the limbs are used. This is where they know they have power, not in the shoulders, arms or legs but starting, rooted in the core. As adults, we have learned that our arms and legs are strong and neglect the trunk, the point where it is all connected.

A common set of movements, sometimes known as the primal movement patterns are, in developmental order:

Flex
Twist
Push
Pull
Squat
Lunge
Walk
Run
Play

We should become like children again and do these every day. Only then will we start to find out how we are restricted and what we need to change to get the best from our bodies.

80:20

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There is an idea called the Pareto law. This says that 80% of the work takes 20% of the time. It can be used in almost any situation, from business management to problem solving, personal training to writing a book. I use it to illustrate a patients recovery plan (and will try to cover this in a post soon).
I also think it applies to our area, not just in terms of treatment processes, but in terms of techniques.Far too many people don’t use their training, expertise and experience sufficiently when working with clients. Instead they fall back on what they know works and do the same thing for everybody. (80% of problems can be solved with 20% of our skill). But every body is not the same. Each client is unique and each time we see them they have changed.

From a therapeutic perspective, this means that we need to reassess and reinterpret them each time, not just do the same thing and hope it will work.

When carrying out a fitness program, this also stands. We can draw up a framework for the series of sessions but need to be flexible enough to modify it as necessary. We should and need to concentrate on what they are saying, how they are responding and whether we are achieving their goals. In either mode, we especially need to take into consideration current research and thinking to ensure we are up to date with what the experts are doing. As with every other part of life, we need to remember the loop: observe, think, apply. Only then will we be doing the best for our clients and ourselves.

T4 / Rib 4 Problems

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I have recently been thinking about the connections between the ribcage and shoulder pain. From this, I have noticed a couple of connections.
The main one is dysfunction around rib 4 either side leading to pain in the same side shoulder and arm. This has typically presented as pain next to the scapula, tension in trapezius and radiating pain down the triceps into the forearm. The patient typically has a history of desk based work or driving, with the pain often coming on waking or after coughing / sneezing. Examination shows restricted thoracic spine and tenderness on the ribs, both sternally and on the spine. Having tried to research this, I struggled to uncover much that enlightened me, other than a chiropractic diagnosis of T4 syndrome, which doesn’t really match and often seems rather vague.
My view is that the symptoms are actually caused by fascial tension and pain related muscular spasm, so fascial release, gentle manipulation and soft tissue treatment can have an apparently miraculous effects on some people. I also do some cranial / functional work anteriorly to re-centre and balance the ribs / fascia.
From this, it has been useful to be able to rapidly assess the motion of the spine. Although a detailed examination is always important, it is useful to be able to have a rough guide as to where you should be looking.

Supine, where the patient lies passively and you use their bent knee to create rotation in the spine, blocking at the pelvis, ribs and shoulder to isolate the main sectors. This is following a simple standing active examination, where the patient attempts the main spinal movements of flexion, rotation and sidebending.As an extension of that, I started getting patients to attempt “monkey”. This is an Alexander technique standing posture, which is meant to demonstrate balance within the spine (my perspective). The most important thing to know about Alexander technique (other than it is really rather good and a couple of lessons from a good teacher is worthwhile, I recommend a number of patients to my local teacher) is that it is all about intention and the mind being in charge of the body, so speed is always controlled.To move into a version of monkey posture ask the patient to do the following:

1) Get them to stand comfortably, feet parallel (check, lots externally rotate to minimise loading in the glutes)
2) Bend the knees slightly
3) Bend forward at the waist, spine straight
4) Let the arms hang loose
This is a german video of a man sitting down, but if you stop half way, its monkey.
What I noticed is that most cannot bend solely at the hips without looking down and treating any thoracic restrictions allows them to move much better.
The reason for all of this is to demonstrate treatment further away from the area of complaint and to look for other areas of compromise in their movement patterns. They may also find cervical and lower limb problems start to surface. Once this has been physically demonstrated, it is easier to achieve compliance in terms of future treatments, exercise pescription and general understanding of their body.
And for a positive patient outcome, this can be used as part of their ongoing exercise plan.

Tonight we dance: Lower back pain, tango and movement

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My friends recently bought a wii for their family and watching them play a dancing game, I noticed something that had been slowly dawning on me for a while.

One of them seemed a little more fluid than the other but as they are all very fit and active, at first I couldn’t understand why.

The answer appears to  lie in the lumbar vertebrae and their apparent lordosis. One of them had a slightly more lordotic spine, with more resulting anteriorisation in the pelvis than the other.

From that, the pieces fell into place. Shortening in the quadriceps and psoas had led to a slight increase in the anterior tilt of the pelvis, in turn reducing the available motion in the lumbar spine.

This pattern can commonly be seen in the wider population, especially those presenting clinically. On examination, we will generally find tight glutes, shortened psoas, a slight medial rotation to the thigh, hypertonicity in the superior insertion of quadratis lumborum, an anterior tilt to the pelvis and restriction motion in one or more planes in the lower lumbar spine. If active, they may also report hamstring problems.

Clinically, resolving this can have several approaches, depending on the level you wish to work. Posteriorise the pelvis (one colleague uses MET of the hamstrings, another does it manually side lying), lengthen the quadriceps, stretch or release any psoas restricitons and work on any QL points. Other, more distal, areas can then be incorporated to address the underlying issues that the body was adapting around. This is where it becomes interesting and the individual practitioners preferences come to the fore.

Once treated, this can often be prevented from returning by regular stretching and, interestingly, regular dancing or hoola-hooping! Both of these activities help keep the spine mobile and fluid, encouraging good movement patterns and core integration. And Tango? Particularly for the ladies, this elegant form of dance requires excellent upper body posture, with the ability to stabilise and extend the pelvis and leg smoothly.

As ever, all problems are individual and should be investigated professionally. None of the information above is a diagnosis or treatment plan.

Program design in fitness

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Following some recent research, I have been thinking about the way we approach fitness training.There is some evidence that there are 2 modes in the body and we need to activate both for the best output. There is the short time, high intensity work and then the long, slow output.The problem is, when we train with people, we don’t focus on these, we fall onto the middle ground. It’s easy. We don’t need to work hard, we don’t need to push the client. But then they don’t improve, they get disheartened and our reputation isn’t enhanced.

Instead of taking them for a jog around the park, change it up. Make them sweat, push them hard. Use the primal patterns, look at complex movements if they are capable of them. And if they’re not, get them ready.

And then guide them to being more active every day (the long slow stuff). Help them change their diet so they eat clean.

They will see changes and you will enhance your reputation too!